A Personal Journey Shaping a Philanthropic Portfolio Along the Three Horizons Framework

by Marion Birnstill

February 16, 2024

Marion Birnstill is a seasoned global health and partnering professional with close to 15 years’ experience spanning a career working for leading organisations across the private, public and non-profit sectors. She is partnering with the School to explore together how we might irrigate our health ecosystems with systems change practitioners, and is a facilitator on Basecamp for Health System Transformation. Marion is also a School Basecamp alum.

In early 2020, just before the world was gripped by the pandemic, I was attending what was going to be the last in person meeting of the Basecamp for system change organised by the School of System Change in Brussels. That’s where I had the privilege of meeting Bill Sharpe, the architect behind the Three Horizons Framework. Our encounter was not just insightful but also timely (some would say a synchronicity), as it equipped me with the tools to navigate the unprecedented challenges that were about to unfold during the “pandemic years”.

Image credit: Matthieu Ricard

The Three Horizon Framework in a nutshell

The Three Horizons Framework is a strategic tool for thinking about the future and managing change over time. It presents three overlapping patterns over time:

  • Horizon 1 represents the current system and dominant way of doing things, focusing on immediate needs and incremental improvements.
  • Horizon 2 is the pattern of activity seeking opportunities for change. In other words, the space where the seeds of innovative ideas and practices begin to emerge, challenging and altering the status quo.
  • Ultimately, Horizon 3 paints a radically different future, showcasing groundbreaking ideas and new embodied qualities and approaches, enabling the rise of new systems better attuned to our evolving world.

The framework allows an understanding on how to navigate from the present to a desirable future, managing both the urgent needs of today and the transformative potentials of tomorrow. It helped me to integrate the strategy of the Johnson & Johnson Foundation and how it may be supportive in moving from the current dismemberment of health systems towards new repatterned (and hopeful) systems.

During the pandemic, the framework kept me sane and hopeful as I was asked to support the company’s COVID19 response and identify partners to collaborate with. While the relevance of our strategic focus around community health and frontline health workers became starkly apparent even essential for managing the crisis–the use of the Three Horizons Framework allowed me to zoom out and see beyond the immediate crisis.

There has never been a timelier moment to ask — what is the Future of Health? The Three Horizons Framework challenged my worldviews and helped me to understand where I stood in the system and what were the opportunities for me to contribute and advocate for a longer-term and systemic view of health system transformation. Using the framework helped me to be more intentional and coherent in the way I shaped my portfolio at the Foundation to support the emergence of a new pattern in Health. It allowed me to actively pursue hopeful imagination — as defined by C.R Snyder as the trilogy of goals, pathways and agency. Through this case study, I intend to share both the process and some of the early outcomes of shaping a philanthropic portfolio along the Three Horizon framework.

Let me share with you how the Three Horizons Framework informed the strategy and the portfolio of the Foundation as well as the valuable insights I gained about the future of health; subsequently, I will delve into some personal insights on effectively utilizing the framework from a philanthropic standpoint.

Horizon 1: 'Confronting the Present'

Acknowledging Current Realities: My journey began by recognizing the effectiveness yet limitations of our existing practices and partnerships. It was about seeing the value in what we were doing while acknowledging the need for deeper change. Exploring the 1st Horizon was instrumental in helping me identify areas where we were merely applying a plaster on complex issues without looking at their root-causes.

Immediate Responsive Actions: I supported the creation of a portfolio of initiatives that provided immediate relief to COVID19 patients and frontline health workers mostly looking at pivoting existing initiatives to ensure their relevance in the unfolding COVID19 context. But I also began planting seeds for deeper, systemic change mostly including resilience-based intervention for frontline health workers, recognizing that COVID19 would have devastating effect on the mental wellbeing of the health workforce. It was a balancing act between supporting current needs and envisioning a different future.

Horizon 2: 'Bridging to Transition'

Supporting system entrepreneurs: I sought partnerships with those on the boundaries and edges of the health system. Together with community health “system entrepreneurs” (as I like to call them) and advocates, we explored initiatives that could bridge our current system to a new desired and hopeful future. This led to the creation of the partnership with Ashoka on “Reimagining Community Health”. More about this here and the support to many initiatives such as Banlieues Santé (France), the International Institute for Positive Health (Belgium and Germany) and Community Mental Health UK. I focused on supporting projects and ideas that embodied a new way of approaching, governing and financing health. These ‘pockets of the future in the present’ were aspirational and powerful beacons of what could be. In addition, these systems entrepreneurs took on the role of “producer” — bringing the different horizons together to deepen the conversation about change and create an ecosystem of change around them.

Supporting Systemic Leadership: Having experienced the profound impact of systemic practice, I became a fervent advocate for investing in the training of health leaders and practitioners, aiming to deepen their understanding and capability to enact systemic change. This commitment involved cultivating a community of health leaders, equipped and eager to navigate the intricate journey of health transformation. This collective endeavor culminated in the co-creation of the Basecamp for Health System Transformation, an innovative collaboration with the School of System Change, where minds meet and strategies form to reshape the future of health. More about this here and here. The next cohort will open soon!

Some reflections: Horizon 2 revealed the transitional strategies emerging from the failing of the current system (H1) — who are those health system entrepreneurs that are the pockets of the future in the present? What are the new health delivery mechanisms that approach health more holistically, what is the future of the health workforce? The focus on humanizing health became increasingly central as a key component that set these initiatives apart. As we transitioned through the pandemic, it became clear that beyond technology and infrastructure solutions, the essence of health and healthcare is deeply human. This phase was about reorienting our approach to prioritize empathy, understanding, and the holistic well-being of individuals and communities. It involved embracing patient-centered care models, promoting community mental health, positive health and recognizing the diverse needs and voices within communities. Humanizing health meant not just treating symptoms but nurturing the whole person, understanding their context, and empowering them as active participants in their health journey. In this transformative space, the second horizon urged us to weave compassion and human connection into the very fabric of our evolving portfolio, ensuring that as we move toward the future, we carry forward a health paradigm that is truly centered around the human experience. More about this here.

Horizon 3: 'Envisioning the Future'

Collective dialogue and sense-making: Through workshops, foresight exercises and research commissioning, I contributed in facilitating dialogues and sense-making spaces to unearth what a resilient, human-centered health system could look like. This was about dreaming big and planting the seeds of where we wanted to go collectively. More about the resilient health system of the future here in collaboration with Forum for the Future and here the research commissioned to the Cambridge Institute for Sustainability Leadership.

Discourses on Health System Transformation: Through collaboration and harvesting expertise of some of the leading minds in health system transformation — I embarked on a journey with the International Futures Forum and ShiftN to help cultivate a rich dialogue about the future of health. This collaboration led to exploring the frontiers of health system transformation and the worldviews and agendas emerging as a result. By articulating these discourses on health system transformation, we hope to bring some of the complexity inherent to health systems change into focus for health leaders, organizations and ecosystems while fostering capacity towards transformation. More about this here.

Some reflections: Horizon 3 opened my eyes to a future where community health is not just a response mechanism but a fundamental pillar of a resilient, proactive health system that acts to keep people healthy as opposed to curing its population. Thanks to the 3 Horizon framework I started to sense into my deeper purpose and how my work at the Foundation could contribute to a deeper paradigm shift- a shift from a disease-centric approach to one that builds resilience, promotes sustained well-being and human flourishing.

Some insights I gathered along the way

Both a framework and a practice: The Three Horizons Framework is both a strategic tool and a practice, offering a structured yet flexible approach for envisioning and navigating towards the future. As a framework, it provides a scaffold for understanding the patterns over time: the patterns present, transitioning through innovation, and moving toward a transformative future. As a practice, it encourages continuous learning, adaptation, and the cultivation of a mindset attuned to long-term systemic change. It’s a method that not only maps out the journey but also embeds the principles of hopeful imagination, resilience, foresight, and inclusivity into the very process of planning and decision-making. It allows you to align attention and intention. It can be used in the most versatile ways to help you gain a zoomed-out picture in your organisation, your ecosystem, your marriage, or your parenting decisions!

Surfacing paradoxes and dilemmas: The Three Horizon framework allows you to engage with the complex choices and paradoxes systems and organizations face in their journey through transformation. It facilitates a deeper exploration of the tensions and trade-offs inherent in systemic change, encouraging a reflective and nuanced approach to decision-making. By understanding and surfacing these paradoxes and dilemmas, rather than avoiding them, leaders and organizations can navigate the uncertainties of transformation more effectively, paving the way for more thoughtful and sustainable futures. We need to cultivate our capacity to hold space for these deeper conversations. This will be paramount in the healing and transformation journey of our existing systems and structures. Acknowledging what keeps us stuck is the first step towards transformation. One of the most prevalent dilemmas I came across is how to value health and wellbeing as opposed to “monetizing” illness. I have since committed to surface and discuss these dilemmas more openly and without judgment (this will lead to another publication soon!).

Emergence and structure: A critical realization emerged about the nature of philanthropy and partnering within the realm of systemic change: the delicate balance between structure and emergence. The use of the Three Horizon framework taught me that effective philanthropy is not just about structured giving but also about nurturing trust and relationship while embracing the unpredictability of emergence. It involved learning to relinquish control where necessary, allowing partnerships to evolve organically. This approach not only fostered deeper, more authentic collaborations but also illuminated the dual nature of system change — it is both a journey and a destination. I came to understand that system change is not solely an outcome to be achieved; it is a continuous process marked by learning, adapting, and evolving.

Change happens in the space between us: I discovered that effective philanthropy extends beyond structured approaches, demanding the cultivation of deep trust as one of the key ingredients enabling us collectively to embrace complexity. The use of the Three Horizon framework highlights the critical importance of relationships and the relational elements in our work. I learned that transformation and change occur in the spaces between us — in the interactions, conversations, and connections we foster. Recognizing this, I placed a greater emphasis on nurturing these relational spaces, understanding that they are the fertile ground in which systemic change takes root and grows.

Creating a Narrative of Hope: I recognized the critical role of hopeful imagination in our current context and the practice of hope as a vital tool to repattern current systems. Utilizing the Three Horizons Framework, I embarked on a transformative journey of storytelling, where each narrative crafted served as a manifestation of this hopeful imagination. This was not merely about telling stories; it was a deliberate practice of embedding hope into our collective consciousness, a way to shift from being responsive to becoming proactively engaged in shaping our collective future.

Spaciousness and wisdom: The 3 Horizon framework offers an opportunity to expand our realm of possibility. Spaciousness plays a transformative role in how individuals and systems perceive and engage with each other, fostering an environment where people feel seen and acknowledged. This spaciousness acts like a mirror, reflecting the system back to itself, thereby enabling it to recognize and detoxify its inherent contradictions. Utilizing the 3 Horizon framework offers a process that encourages awareness of the present state in a healthy, non-judgmental manner, recognizing the patterns that keep us anchored in unproductive cycles. By acknowledging these elements without assigning blame, we pave the way for wisdom to emerge.

This wisdom becomes particularly potent in conversations around polarities. It allows for richer, more inclusive dialogues, where diverse viewpoints are not just tolerated but valued as essential components of a holistic understanding. In this space, flourishing and future consciousness can truly take root, moving us beyond the narrow confines of our usual perceptions of reality.

Embracing our collective contradictions is crucial for realizing our potential for wholeness. These contradictions, rather than being obstacles, are gateways to a field of possibilities. It’s in the act of acknowledging and holding our individual and collective contradictions that we find the space to expand our conversations and our consciousness of the future. This expanded dialogue and understanding are vital for fostering a sense of wholeness, where the full spectrum of human experience and thought is integrated, leading to more comprehensive and sustainable solutions for the challenges we face.


My journey with the Three Horizons Framework has been a beacon of hope, inspiring a transformative shift in my approach to philanthropy. This experience has taught me that hope is not merely an aspiration but a dynamic practice. It’s about reframing challenges into opportunities, reshaping the familiar patterns of the status quo, and reclaiming our collective capacity for imagination and action. This empowered approach has enabled my partners and me to transcend the bounds of merely reacting to crises. Instead, it has allowed us to envision and actively forge a path towards a resilient, proactive future. Hope, in this context, emerges as a potent force driving systemic change, a catalyst that empowers us to reclaim our agency in the creation of a better world.

It is my hope that this narrative serves not just as a testament to the journey undertaken but as an invitation to others in the world of philanthropy to embrace the Three Horizons Framework. Let it guide and inspire us all to shape our efforts and investments in a way that truly fosters systemic change, hope, and resilience for the future.


If you would like to develop your systemic practice alongside a supportive community of peers, please explore School of System Change learning offerings.